So no one has an answer for me? Is it too hard of a question?
**curlcoat **- shut up until I get my answer! You make it too easy for people to avoid the real questions!
That seems to me to be a rather important point, and one where the UHC plans begin to break down. As distasteful as it seems, yes, there will need to be a point at which the cost-benefit numbers must be calculated.
This child will need thousands in neo-natal care, then years of therapy and surgery. And then, like Broomstick’s husband, it may go on to live a full life and become a member of society. On the other hand, the baby may just die. Because of finite resources, someone at some point is going to have to draw a line. This applies to cancer patients, victims of severe trauma, like brain injury leading to coma, and all other sorts of hard choices.
The right and left spun this into a tizzy under the (incorrect) term “death panels” and in all of that furor, the actual question was lost.
I think this question was dismissed far too quickly and lightly, as the whole curlcoat thing got so overblown.
Clearly if the US goes with a universal health care system, there will be rationing (please, lets not be Sarah Palin and start crying about death panels). There would have to be rationing because not every treatment is efficient in terms of dollars spent and life/health saved. Its a lot easier to make these decisions on the other end of life: in other words someone whose 70 will likely not get the most expensive treatment as someone who is 30, just due to $ spent and amount of life remaining.
The real issue is this particular situation, which I think Sateryn has been carefully bringing forward. This is tricky because it does revolve around babies, but where do you draw the line in universal health care? If the baby has a 50% chance of survival to the age of 5, but only after $1mm in expenditures, do you continue? (obviously, I am making up probabilities and dollars to serve as a point for discussion.)
If you say: its a baby, they have the right to try to make that 50%, and yes we should spend $1mm, then where do you draw the line with adults making poor health decisions? If (as an example) I love to smoke (I’m actually a non-smoker) and really don’t want to quit, because I enjoy cigarettes, shouldn’t I be allowed to drop $1mm on my health issue?
Maybe I should take this to GD, but sometimes there is good discussion in the pit. Looks like Sateryn is still trying to keep the discussion going!
The advent of UHC will not, by its very existence, eliminate all such painful ethical questions. I very much doubt anyone has claimed that it would.
of course it doesn’t eliminate the painful questions, I am asking (and I think Sateryn is too) what this board thinks the answer should be. I am relatively new here, but I am always seeing someone here with “the answer” to just about anything (not that I always agree), so I want to see someone who supports UHC to answer this question. If we can’t answer it, why do we expect politicians to be able to answer it. They are not smarter than we are.
Would UHC lead to rationed health care? We already have rationed health care, it is rationed according to ability to pay. A lot of us don’t think that’s a very good idea.
One of our UK Dopers reported that his or her 90-year-old grandmother received expensive surgery (possibly a transplant?) even though she was near the end of her life. That poster reported that the grandmother’s age was not a factor in whether or not she would receive treatment. She needed treatment, and she got it.
Just a data point.
I understand this and I agree with your statement, while I was not originally a proponent of UHC, I have become one in the recent months, due to this argument (among others).
That’s not the question I am posing however. I am asking if anyone reading this thread has any idea of a better rationing method? And if you cannot see that sometimes the decision will have a monetary component, then sit down and be quiet, because that is unrealistic. There is a finite amount of money, we can’t all always get all the care we want.
So, does $1mm in expenditure make sense to give a baby a 50/50 chance of living to the age of 5? (Again, I am making this up, so that we have something concrete to discuss, otherwise the discussion will be rambling and pointless.)
Excellent post, Otter, and one at the crux of the issue.
At the end of the day, you can ration by money or fiat. If fiat, who makes the call, the ins company, working within market forces and under some government regulatory body, or some faceless gov board? (How many bitch/whine posts have we seen here about people getting some SSI claim denied? Prepare for more of the same…)
I’m glad to see that one of the UHC cheerleaders here (of which I’m not one, mainly due to the crushing effect it will have on the country’s finances and deficit) realizes that it won’t be perfect… no system would be, since we don’t have infinite resources.
When some say that ‘life is priceless’, etc, I’m reminded of a line by George Will (I’m paraphrasing here), "Life isn’t priceless, otherwise the speed limit would be 5 mph’. My boy Cecil actually glances on this subject, cost-benefit to death prevention, in his piece on radiation shields on airplanes, here
Anyway, well done Otter
The way it generally has worked is government establishes roughly the percent of GDP it will commit to UHC - somewhere usually between 9-10%. Most years GDP goes up, some years it doesn’t.
In the lean years that means UHC suffers like the school system or the military budget - either that or you borrow more because it’s an election year.
‘Rationing’ is a misnomer as I understand it, a waiting list develops is all - as the quantity of service available is reduced in line with allocated resources (as said usually GDP). You just cut your cloth accordingly - most years the cloth gets bigger.
It’s a simplification but an approximation.
UHC will drop costs. The insurance companies take over 30 percent for administering and denying coverage. We pay double what other countries pay. The insurance companies just dump the sick or expensive onto the public . Who could not make money with that business model? They just jack prices up while cutting coverage.
Even a public option could lower prices. We have no choice now. We can pick between companies that are all at about the same price. One or 2 companies monopolize almost every states health care. Then every year they crank up prices and cut coverage. We just love mergers in America. We watched oil companies and health care companies swallow up the competition for decades. Now they are big enough to set prices , make the laws and own those who regulate them.
This a fantastic way to focus that issue, and I’m interested in the reponses.
My other question is more of a philisophical one - Most UHC people agree that society as whole has a real interest in a healthy population, and therefore tax contributions should be made because it’s the right thing to do.
So, do patients have an opposite duty, to make sure that they are using healthcare wisely and efficiently? This is a case where a premature baby is a good example.
I would take a net loss under most of the healthcare bills being floated around now, because I am (thankfully) healthy and would therefore contribute more than I use. But, I am told to stop grumbling, because of The Greater Good.
It would seem to me that, on the other side of the coin, when a baby is born just past the limit of viability, the parents and medical providers should examine the costs and benefits of using hundred of thousand of dollars for their baby, that may not even make it. Of course, it’s* their baby*, but to me, harsh as it seems, it’s just an expense. That sounds harsh, and I’ve had experience with close friends with a premie, but if you remove emotion from the equation, that’s how it shakes out.
I’m afraid Wiki doesn’t agree with you
Also, some would argue that the ‘administrative overhead’ isn’t purely just marketing dollars and denying claims, just to inflate profits/screw the little guy. There are the steps like building provider networks, processing claims, investigating fraud, negotiating rates.
I’d argue that those costs will still exist regardless if the UHC utopia gets implemented or not. Maybe there’d be some economy of scale, maybe not.
Ok, back to the hypothetical. Its 2009, the fetus is 6 months along and is expected to be born in 2010. Based on medical diagnoses of a genetic disorder, they doctors agree (multiple opinions) that this child (when born) will need $1mm in surgery/therapy to have a 50/50 chance of survival to the age of 5. The baby is born in 2009, as a preemie, and there are not enough funds in the GDP UHC bucket to cover even the first treatment, only the birth (and regular preemie care (not sure what its properly termed). (even assuming gonzomax is right and costs have gone down across the board.) Its not an election year. If you put the child on a waiting list, it will (for sure) die. If you start the procedures, the first one will run about $500k (heart surgery) and if the other procedures don’t start very quickly thereafter, the child will die (due to liver failure, kidney failure). (I guess technically I am assuming a GDP UHC budget year to run Jan-Dec, shift the months as appropriate, but don’t dodge the question!)
Does the child get the care?
This is the tough question that gets drowned out in all the noise. Yes its hypothetical, but I would find it hard to believe that there aren’t medical treatments and cases like this. To be fair, I am not really a “proponent”, I am actually a waffler: I was against it for a while, but I see that the people for it also have good points, now I just want it done so everyone will STHU. I just don’t want this true ethical dilemma (which will become a real life ethical dilemma) lost in all the noise.
I have a hunch, and it is no more than a hunch, and it is based solely on my impression that curlcoat has some self-interested reason for being so pro-health-insurance-industry, that this is not likely to occur unless single-payer comes to pass, and the industry stops existing.
Once again, it’s only a hunch, and there’s nothing to suggest that it’s correct except my own impressions.
No offense to kaylasdad but I am going to see if I can take this argument over to Great Debates. I am little tired of hearing about curlcoat and all that crap.
Great Debates for those interested in the discussion.
7% is the total amount spent on administrative costs, which includes the amounts spent by Medicare and Medicaid, workers’ compensation carriers, PIP and other non-health-insurance carriers, and private citizens.
Of the amounts spent by health insurance providers, 30% goes to administrative costs.
Sorry, I’m going to have to see some proof of that.
This Forbes piece claims that Medicare is 4%, private insurance is 12%.
and much of the 12% is spent weeding out fraud to reduce costs (or denying claims/screwing the little guy, depending on your POV)
Does that 30% include such costs as the salaries for highly placed and crucial executives, to prevent them wandering away to more lucrative positions?